Functional Ovarian Cysts

Topic Overview

What is a functional ovarian cyst?

A functional
ovarian cyst is a sac that forms on the surface of a woman's
ovary during
or after ovulation. It holds a maturing egg. Usually the sac
goes away after the egg is released. If an egg is not released, or if the sac
closes up after the egg is released, the sac can swell up with fluid.

Functional ovarian cysts are different from ovarian growths caused by
other problems, such as cancer. Most of these cysts are harmless. They do not
cause symptoms, and they go away without treatment. But if a cyst becomes
large, it can twist, rupture, or bleed and can be very painful.

What causes functional ovarian cysts?

A functional
ovarian cyst forms because of slight changes in the way the ovary makes or
releases an egg. There are two types of these cysts:

A follicular cyst occurs when a sac on the
ovary does not release an egg, and the sac swells up with fluid.

A
luteal cyst occurs when the sac releases an egg and then reseals and fills with
fluid.

What are the symptoms?

Most functional ovarian
cysts do not cause symptoms. The larger the cyst is, the more likely it is to
cause symptoms. Symptoms can include:

Pain or aching in your lower belly, usually
when you are in the middle of your menstrual cycle.

A delay in the
start of your menstrual period.

Vaginal bleeding when you are not
having your period.

Some functional ovarian cysts can twist or break open
(rupture) and bleed. Symptoms include:

Sudden, severe pain, often with nausea and
vomiting.

Pain during or after
sex.

If you have these symptoms, call your doctor right away.
Some ruptured cysts bleed enough that treatment is needed to prevent heavy
blood loss.

How are functional ovarian cysts diagnosed?

Your
doctor may find an ovarian cyst during a routine
pelvic examination. He or she may then use a pelvic
ultrasound to make sure that the cyst is filled with
fluid.

If you see your doctor for pelvic pain or bleeding,
you'll be checked for problems that may be causing your symptoms. Your doctor
will ask you about your symptoms and menstrual periods. He or she will do a
pelvic examination and may do a pelvic ultrasound.

How are they treated?

Most functional ovarian
cysts go away without treatment. Your doctor may suggest using heat and
medicine to relieve minor pain.

If a large cyst bleeds or causes
severe pain, you can have surgery to remove it.

Your doctor may
suggest that you take birth control pills, which stop ovulation. This may
prevent new cysts from forming.

Cause

A
functional ovarian cyst is caused by one or more
slight changes in the way the ovary produces or releases an egg. During the
normal monthly menstrual cycle, one of two types of functional cysts may
develop:

A follicular, or simple, cyst occurs when the
small egg sac (follicle) on the ovary does not release an egg, and it
swells with fluid either inside the ovary or on its surface.

A
luteal, or corpus luteum, cyst occurs when the remains of the egg follicle do
not dissolve and continue to swell with fluid. This is the most common type of
ovarian cyst.

The development of functional cysts is also common during
treatment with
clomiphene (such as Clomid or Serophene) for
infertility. These cysts go away after treatment is
completed, though this can take several months. They do not appear to endanger
pregnancy.

Other ovarian growths

There are other types of ovarian cysts
and growths caused by other conditions. An ovarian growth can be a non-cancerous
(benign) cystic tumour or related to
endometriosis or cancer. In some cases, what seems to
be an ovarian mass is actually growing on nearby pelvic tissue. This is why
it's important for you to have regular pelvic examinations and for your doctor to
carefully diagnose any cysts or growths felt on your ovaries.

Symptoms

Functional ovarian cysts usually are harmless, do not
cause symptoms, and go away without treatment. Ovarian cysts are often
discovered during a
routine pelvic examination.

The larger the
ovarian cyst is, the more likely it is to cause symptoms. When symptoms occur,
they may include:

Frequent urination, if a large cyst is pressing
against your bladder.

Abdominal (belly) pain.

Menstrual period
changes.

Weight gain.

More severe symptoms may develop if the cyst has twisted
(torsion), is bleeding, or has ruptured. See your doctor immediately if you
have any of the following pain, shock, or bleeding symptoms:

There are many
other conditions that cause signs or symptoms of a
functional ovarian cyst. This is why it's important to have any unusual pelvic
symptoms checked and to have regular annual pelvic examinations.

What Happens

Most
functional ovarian cysts cause no symptoms and go away
without treatment in 1 to 2 months or after 1 to 2 menstrual periods. Some
cysts grow as large as
10 cm (4 in.) in diameter
before they shrink or rupture. A rupturing functional cyst can cause some
temporary discomfort or pain.

What to think about

Functional ovarian cysts do
not cause
ovarian cancer. But your doctor must rule out other
possible types of ovarian cysts or growths before diagnosing a functional cyst.
This may involve another pelvic examination, a pelvic
ultrasound, or possibly a
laparoscopy procedure to closely examine the cyst and
its ovary.

Cysts after menopause. After
menopause, ovarian cancer risk increases. This is why
all post-menopausal ovarian growths are carefully checked for signs of cancer.
Some doctors will recommend removing the ovaries (oophorectomy) when any kind
of cyst develops on an ovary after menopause. But the trend in medicine seems
to be moving away from surgery for small and simple cysts in post-menopausal
women. In the 5 years after menopause, some women will still have functional
ovarian cysts now and then. Some post-menopausal ovarian cysts, called
unilocular cysts, which have thin walls and one
compartment, are rarely linked to cancer.

What Increases Your Risk

A
functional ovarian cyst sometimes develops near the end of the
menstrual cycle, when an egg
follicle fills up with fluid. Factors that may
increase your risk for developing a functional ovarian cyst include:

A history of a previous functional ovarian
cyst.

Current use of clomiphene, such as Clomid or
Serophene, to start
ovulation.

Use of low-dose
progestin-only contraception (such as some implants, pills, and IUDs).

Examinations and Tests

If you see your doctor for pelvic
pain or bleeding, you'll be checked for a number of conditions, including an
ovarian cyst, that may be causing your symptoms. Your
evaluation will include a
pelvic examination, a history of your symptoms and menstrual
periods, a family history, and a
transvaginal ultrasound (which uses a narrow wand
placed in the vagina). See an image of
ovarian cysts.

If your doctor discovers an ovarian cyst during a
routine pelvic examination, a transvaginal or abdominal ultrasound can help show what
kind of cyst it is.

When is further testing needed?

If an
ultrasound shows that you have a fluid-filled functional ovarian cyst, and it
isn't causing you severe pain, your doctor will probably suggest a watchful
waiting period. You can then have the cyst checked 1 to 2 months later to see
whether it is changing in size. Most cysts go away in 1 to 2
months without treatment or after 1 or 2 menstrual periods.

Your doctor will recommend further testing or treatment if:

Initial ultrasound doesn't clearly show what
kind of cyst or growth is present, or both ovaries are
affected.

You are not ovulating during your initial examination
(because you are either a
post-menopausal woman or a girl not yet menstruating).
Without ovulation, a new functional cyst would be highly unlikely, so other
possible conditions are explored.

You have moderate to severe pain
or vaginal bleeding.

A diagnosed functional ovarian cyst does not
get smaller or go away as expected.

An ovarian growth or cyst
(mass) is larger than
7.5 cm (3 in.).

You have
risk factors for ovarian cancer, such as a strong family history of the disease or gene changes. The higher your risk of ovarian cancer, the
more likely aggressive testing will be recommended to find out the cause of an
ovarian mass.

Further testing

Laparoscopy allows a surgeon to look
at the ovary through a lighted viewing instrument and take a sample of the
growth (biopsy). After testing the sample, the surgeon can decide whether to
surgically remove the cyst (cystectomy) or the entire ovary (oophorectomy). If
there is concern about ovarian cancer, a laparotomy (instead of a laparoscopy)
may be done. Then, if cancer is found, the surgeon can safely remove the
ovaries.

CA-125 (cancer antigen) test is only
recommended for women with a very high risk for ovarian cancer. These are women
with a significant family history of the disease. This blood test result is
combined with ultrasound results, because it doesn't give a highly dependable
diagnosis on its own.

Treatment Overview

Most
functional ovarian cysts are harmless, do not cause
symptoms, and go away without treatment. When treatment is needed, treatment
goals include:

Relieving symptoms of pelvic pain or
pressure.

Preventing more cysts from developing by preventing
ovulation (if recurrence is a problem). Treatment with
birth control pills prevents ovulation.

Initial treatment

Because
functional ovarian cysts typically go away without
treatment, your doctor may recommend a period of
observation without treatment (watchful waiting) to see whether your
ovarian cyst gets better or goes away on its own. Your doctor will do another
pelvic examination in 1 to 2 months to see whether the cyst has changed in
size.

If an ovarian cyst doesn't go away, your doctor may want to do more tests to be sure that your symptoms are
not caused by another type of ovarian growth. Home treatment with heat and
pain-relieving medicine can often provide relief of bothersome symptoms during
this time.

Ongoing treatment

A
functional ovarian cyst that doesn't go away, has an unusual appearance on
ultrasound, or causes symptoms may require treatment
with either medicines or surgery.

Your doctor may suggest that you try
birth control pills for several months to stop more cysts from
forming.

Surgical removal of the cyst (cystectomy) through a small
incision (laparoscopy) may be needed if a painful functional
ovarian cyst does not go away despite medical treatment. If a cyst has an
unusual appearance on ultrasound or if you have other risk factors for
ovarian cancer, your doctor may recommend surgical
removal through a larger abdominal incision (laparotomy)
instead of by using laparoscopy.

What to think about

Cysts after menopause. After
menopause, ovarian cancer risk increases. This is why
all post-menopausal ovarian growths are carefully checked for signs of cancer.
Some doctors will recommend removing the ovaries (oophorectomy) when any kind
of cyst develops on an ovary after menopause. But the trend in medicine seems
to be moving away from surgery for small and simple cysts in post-menopausal
women. In the 5 years after menopause, some women will still have functional
ovarian cysts now and then. Some post-menopausal ovarian cysts, called
unilocular cysts, which have thin walls and one
compartment, are rarely linked to cancer.

Prevention

Functional ovarian cysts cannot be prevented if you
are
ovulating. Anything that makes ovulation less frequent
reduces your chance of developing an ovarian cyst.
Birth control pills, pregnancy, and
breast-feeding in the first 6 months following birth
prevent ovulation. Ovulation ceases when
menopause is complete.

Home Treatment

Home treatment can help relieve the
discomfort of
functional ovarian cysts.

Use heat, such as a hot water bottle, heating
pad, or warm bath, to relax tense muscles and relieve cramping. Be careful not
to burn yourself.

Use pain relievers you can get over-the-counter.
Acetaminophen (such as Tylenol),
non-steroidal anti-inflammatory drugs (NSAIDs) (such as
Advil or Aleve), and
ASA (such as Aspirin) are all pain medicines you can
buy without a prescription.

Herbal teas, such as chamomile, mint,
raspberry, and blackberry, may help soothe tense muscles and anxious
moods.

Empty your bladder as soon as you have the urge to
urinate.

Avoid constipation. Constipation does not cause or treat
ovarian cysts but may further increase your pelvic discomfort. For more
information, see the topic
Constipation, Age 12 and Older.

Medications

Treatment with medicine may be useful if
you have recurrent, painful
functional ovarian cysts.

Birth control pills (oral contraceptives) are
used to prevent
ovulation. Without ovulation, the chance that ovarian
cysts will form is reduced and your symptoms may be
relieved. Although birth control pills do not make ovarian cysts go
away any faster, their use may prevent new cysts from forming.

What to think about

Birth control pills have not
been shown to get rid of or shrink ovarian cysts that have already formed. Some
studies show that the cysts shrink at the same rate with or without birth
control pill use.1

Surgery

Surgery may be needed to confirm the
diagnosis of an
ovarian cyst or to evaluate ovarian growths when
ovarian cancer is possible. Surgery does not prevent
ovarian cysts from coming back unless the ovaries are removed
(oophorectomy).

Surgery choices

Laparoscopy may be used to confirm the diagnosis of
an ovarian cyst in a woman of child-bearing age. Persistent, large, or painful
ovarian cysts that have no signs of cancer risk can be removed during
laparoscopy, leaving the ovary intact.

Laparotomy is used when an
ovarian cyst is very large, ovarian cancer is suspected, or other problems with
the abdominal or pelvic organs are present. If cancer is found, the larger
incision lets the surgeon closely examine the entire area and more safely
remove all cancerous growth.

What to think about

For the most part, functional
ovarian cysts stop forming when
menopause occurs (in rare cases, a functional ovarian
cyst will occur or persist within 5 years of menopause). Relieving symptoms
with medicine until menopause is complete may be an option.

Some
women prefer the risks of surgery to symptoms that reduce their quality of
life. If your doctor recommends surgery, ask whether
laparoscopic surgery or laparotomy would be the best
choice for you.

Unless the ovaries are removed, surgery does not
prevent the formation of new functional ovarian cysts.

Other Treatment

No other treatment for
functional ovarian cysts is available at this
time.

FIND Services and Resources

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.

Is it an emergency?

If you or someone in your care has chest pains, difficulty breathing, or severe bleeding, it could be life-threatening. Call 9-1-1 or the local emergency number immediately. If you are concerned about a possible poisoning or exposure to a toxic substance, call Poison Control now at 1-800-567-8911.